- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.96 / $4,723.00 / $10,635.00
| Facility | | $606.96 | $4,723.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $3,175.00 / $8,800.00
| Facility | | $1,152.00 | $3,175.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.83 / $472.60 / $584.94
| Facility | | $393.83 | $472.60 | $584.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.00 / $4,383.00 / $6,522.00
| Facility | | $2,233.00 | $4,383.00 | $6,522.00 |